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From Fragmented to Coordinated: The Big Data Challenge

Posted on November 27, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

When healthcare organizations have access to as much data as possible, that translates into improved coordination and quality of care, reduced costs for patients, payers and providers, and more efficient medical care. Yet, there is a void in the healthcare data landscape when it comes to securing the right information to make the right decision at the right time. It is becoming increasingly critical to ensure that providers understand data and are able to properly utilize it. Technologies are emerging today that can help deliver a full picture of a patient’s health data, which can lead to more consistent care and the development of improved therapies by helping providers derive better insights from clinical data.

Across the country, patient data resides across multiple systems, and in a variety of structured and unstructured formats. The lack of interoperability makes it difficult for organizations to have access to the data they need to run programs that are critical to patient care. Often, various departments within an organization seek the same information and request it separately and repeatedly, leading to a fragmented picture of a patient’s health status.

Managing Complexity, Inside and Out

While analytics tools work well within select facilities and research communities, these vast data sets and the useful information within them are very complex, especially when combined with data sets from outside organizations. The current state of data illiquidity even makes it challenging to seamlessly share and use data within an organization.

For example, in the life sciences arena, disease staging is often the foundation needed to identify a sample of patients and to link to other relevant data which is then abstracted and mined for real world use; yet clinical and patient reported data is rarely documented in a consistent manner in EHRs. Not only do providers often equivocate and contradict their own documentation, but EHR conventions also promote errors in the documentation of diagnostic findings. Much of the documentation can be found in unstructured EHR notes that require a combination of abstraction and clinician review to determine the data’s relevance.

Improved Interoperability, Improved Outcomes

Problems with EHR interoperability continue to obstruct care coordination, health data exchange and clinical efficiency. EHRs are designed and developed to support patient care delivery but, in today’s world of value-based care, the current state of EHR interoperability is insufficient at best.

Consider the difficulty in collecting a broad medical data set. The three largest EHRs combined still corner less than one-third of the market, and there are hundreds of active EHR vendors across the healthcare landscape, each bringing its own unique approach to the information transfer equation. Because many hospitals use more than one EHR, tracking down records for a single patient at a single hospital often requires connecting to multiple systems. To collect a broader population data set would require ubiquitous connection to all of the hundreds of EHR vendors across the country.

The quality integration of health data systems is essential for patients with chronic conditions, for example. Patients with more serious illnesses often require engagement with several specialists, which means it is particularly important that the findings and data from each specialist are succinctly and properly communicated to fellow doctors and care providers.

Leveraging Technology

As the industry matures in its use of data, emerging technologies are beginning to break down information road blocks. Retrieving, digitizing and delivering medical records is a complex endeavor, and technology must be layered within all operations to streamline data acquisition and make executable data available at scale, securing population-level data more quickly and affordably.

When planning to take advantage of new advanced technologies, seek a vendor partner that provides a mix of traditional and emerging technologies, including robotic process automation (RPA), computer vision, natural language processing (NLP) and machine learning. All of these technologies serve vital functions:

  • RPA can be used to streamline manually intensive and repetitive systematic tasks, increasing the speed and quality at which clinical and administrative data are retrieved from the various end-point EHRs and specialty systems.
  • NLP and neural networks can analyze the large volume of images and text received to extract, organize and provide context to coded content, dealing with ambiguous data and packaging the information in an agreed-upon standard.
  • With machine learning, an augmented workforce can be equipped to increase the quality of records digitization and the continuous learning across the ecosystem, where every touchpoint is a learning opportunity.

Smarter, faster and more qualitative systems of information exchange will soon be the catalysts that lead paradigm-shifting improvements in the U.S. care ecosystem, such as:

  • Arming doctors with relevant information about patients
  • Increasing claims accuracy and accelerating providers’ payments
  • Empowering universities and research organizations with timely, accurate and clinically relevant data sets
  • Correlating epidemics with the preparedness of field teams
  • Alerting pharmacists with counter-interaction warnings

Ultimately, improving information exchange will enable healthcare industry professionals to elevate patient safety and quality, reduce medical and coding errors tenfold and enhance operational efficiencies by providing the relevant data needed to quickly define treatment.

Achieving this paradigm shift depends almost entirely on taking the necessary steps to adopt these emerging technologies and drive a systematic redesign of many of our operations and systems. Only then will we access the insights necessary to truly impact the quality of care across the healthcare landscape.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Bridging the Communication Gap Between Health Plans and Providers

Posted on October 3, 2018 I Written By

The following is a guest blog post by Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Effective communication and trust are the essential keys to any relationship, and the plan-provider relationship is no different. A shift towards value-based coordinated accountable care has urged health plans and providers to collaborate to improve population health and patient experience while lowering costs. Most plan-provider communication revolves around rate negotiations.

An open, honest relationship with transparent communication and cooperation is needed to bridge the communication gap and create mutually beneficial partnerships. Sharing data, creating health plan-provider networks, utilizing audits and providing access to new technologies are all methods health plans and providers could use to help promote collaboration and bridge communication.

Data Sharing Across the Care Continuum

To foster collaboration, data sharing should be implemented and incentives should be aligned across the care continuum so that both parties are motivated to improve outcomes and lower costs. Data sharing is one of the key benefits of bridging the communication gap between health plans and providers.

Health plans hold the bulk of useful data and, when that data is combined with the providers’ clinical expertise, the likely result is better patient outcomes. Sharing data gives providers access to claims information that also provides with them a patient’s entire medical history. This information is useful in helping educate patients about their health risks and to boost transparency in plan-provider communication.

Health plans and providers keep a vast amount of patient information. Health plans have historical claims data while providers have clinical data. Both parties use their data for checks and balances and to mutually determine the best treatment and most appropriate care for patients. Lack of collaboration, usually due to interoperability challenges, means both data types aren’t shared. A key aspect to achieving collaboration and alignment is trust. Sometimes parties are lacking in trust when it comes to the use of their data; however, advancements in technology and use of the blockchain to create transparency are helping to change the tides.

Health plans and providers must have upfront discussions on what information will be shared, and each party must share data that is useful to the other. For health plans, this means understanding how reimbursement is determined, the factors that influence the payments they receive and how they are reimbursed based on clinical outcomes rather than interventions delivered. In turn, providers must clearly communicate the clinical outcomes health plans are or are not achieving. Ultimately, all measures should include preventative care, lower per capita cost and improve population health as well as patient experience and satisfaction. They should also improve how data is managed and transitioned. Providers that implement a strategic quality management approach to deliver high-quality, valued-based care can achieve better clinical outcomes.

Health Plan-provider Networks

Plan-provider communication networks are needed to efficiently and effectively harness data from both parties and enable rapid innovation and the sharing of real-time data for immediate response. Health plan-provider networks utilize care management, electronic health records (EHRs), and analytics to seek to resolve communication and collaboration challenges between health plans and providers. In keeping with HIPAA regulations, communication between health plans and providers must be customized to include only information that is relevant to specific attributed patient populations, physicians, reimbursement and care delivery models. The goal of plan-provider networks is to present both parties with transparent, high-quality data to improve trust and increase health plan-provider engagement to improve communication and, ultimately, population health.

Using Audits to Bridge Communication

The rise of audit requests has posed a problem in the plan-provider relationship. Both health plans and providers must work toward greater compliance, and auditing medical records is a crucial step in the process.

Providers struggle with numerous types of information requests from various third-party health plans, governmental agencies and national health plans, which often have different deadlines and vernaculars. As a result, health plans are forced to repeatedly call health information management (HIM) and audit departments when claims data inaccurately identifies place of service, provider or other patient information. An upsurge in audit requests from commercial and other health plans threatens to exacerbate these problems.

The audit process can change the plan-provider relationship from adversarial to advantageous by improving communication. Bridging communication gaps and language barriers through clearer record requests would take the burden off providers and alleviate plan problems. Technology will also play a critical role in making this entire process as automated as possible.

Chart requests that come from commercial health plan audits represent just five percent of all requests that providers receive. Hospitals also receive high volumes of medical record requests from other hospitals, physicians, attorneys, patients and more. The problem is that commercial plans often assume they are the only requestor. Education is required on both sides of the audit equation to improve processes and reduce plan-provider friction.

For providers, all data from each request and submission should be entered in a centralized audit management software application for the organization. This helps providers track audit activity by health plan and type of audit, maintain a record of all documents sent, better manage requests, and stay abreast of audit trends.

Patient access, clinical coders, billers and collectors perform unique functions and speak different languages across the hospital revenue cycle. Similarly, commercial health plans have multiple departments and terminology involved in audit processing. In many cases, inter-departmental communication and language barriers are the main obstacles to overcome.  However, technology is playing a growing role in creating greater transparency within the healthcare ecosystem—by acquiring, digitizing and giving shape to both structured and unstructured records.

Time Will Tell

Bridging the communication gap will not happen overnight. It will take time and effort from all parties involved; however, these methods are a good starting point.

As the digital era has taken hold, our attentions are turning to a better utilization of the vast data flowing through both providers and health plans. This will translate into a better understanding of patient outcomes, improved revenue cycles and more insightful growth strategies for all parties.

About Ciox
Ciox, a health technology company and proud sponsor of Healthcare Scene, is dedicated to significantly improving U.S. health outcomes by transforming clinical data into actionable insights. Combined with an unmatched network offering ubiquitous access to healthcare data, Ciox’s expertise, relationships, technology and scale allow for the extraction of insights from structured and unstructured clinical data to create value for healthcare stakeholders. Through its HealthSource technology platform, which includes solutions for data acquisition, release of information, clinical coding, data abstraction, and analytics, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability. Ciox improves data management and sharing by modernizing workflows and increasing the accuracy and flow of information, while providing transparency across the healthcare ecosystem and helping clients manage disparate medical records. Learn more at www.ciox.com.

Centralizing HIM Operations: An Enterprise Approach

Posted on August 15, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox.

Technological advances, policy changes and organizational restructures are continuously bringing trends to the healthcare industry, specifically impacting healthcare facilities. Centralization of operations is one of those trends. Driven by a value-based model, the centralization of health information management (HIM) aims to streamline operations, standardize processes, reduce costs and improve quality of care and patient satisfaction.

Oftentimes, HIM departments operate with disparate processes due to legacy standard processes and acquisitions of new entities and are unable to efficiently integrate and access information when it is derived from multiple sources. This causes inconsistencies in processes and procedures, as well as incompleteness of information and unavoidable redundancies. Furthermore, decentralization can result in risks such as ineffective information management, inaccurate coding and breaches.

Silos of information hinder standardization, and as a result create compartmentalized pockets of information from sources, slowing down communication and making change more difficult. However, through the use of electronic HIM technology, secure information can be shared and processed across various departments and facilities at a quicker pace than ever before. Taking these efficiencies one step further, instead of siloes of information, many organizations are moving to a centralized model that can reduce operational costs by streamlining organizational performance, establishing consistent processes through standardization and eliminating redundancies.

Patient health information must be linked across the healthcare continuum to provide the best quality of care. Additionally, sources of information must be linked to electronic health records (EHRs) to support centralization and enhance patient care. To connect silos and reduce risks, healthcare facilities must centralize HIM operations to create standardization and improve coordination across the continuum of care.

Benefits of Centralization

Healthcare facilities can greatly benefit from incorporating the centralization of HIM operations into their long-term organizational plans. In fact, the benefits are greater than any hurdles encountered during the transition. Benefits include:

  1. Improves operational efficiency: Moving from a fragmented system to a model that streamlines operations improves efficiency and decreases administrative and operational costs.
  2. Eliminates redundancies and reduces errors: Helps to standardize processes, procedures and forms across a healthcare system to ensure they are the same throughout facilities.
  3. Improves financial performance: Restructuring improves productivity and efficiency as resources are centrally located, which positively impacts the bottom line.
  4. Fosters collaboration: Eliminates silos of communication that cause a stagger in the flow of information – improving communications and optimizing patient outcomes.
  5. Increases accessibility: Provides the benefit of system-wide accessibility to patient information for release purposes, such as billing and coding.
  6. Optimizes workflow: Allows opportunities to reexamine workflows for optimal efficiencies across the HIM continuum, bringing business value.

Driving Transition Towards Centralization

When an organization transitions to centralized HIM operations, it’s important that the journey be completed with the right preparation and execution. HIM professionals must establish processes that foster opportunities for consolidation and standardization that then result in reduced cost, mitigation of risk and overall improved patient care.

Prior to implementing a centralized model, HIM professionals must take certain steps into consideration:

  • Acquire an executive sponsorship to provide direction, support, budget and resolution to potential problems that may arise during the transition.
  • Establish a multidisciplinary steering committee to address centralization and your organization’s information policy, aligning resources with strategy.
  • Identify challenges, gaps, risks and opportunities while working with collaborators to achieve goals for improvements.
  • Define and establish standards, processes and procedures.

Centralization: The Decision is Yours

It is important for HIM professionals to be proactive when determining his or her organization’s vulnerabilities and address them immediately, as breaking down barriers that add risk ultimately drives down costs and improves efficiencies.

Additionally, everyone in an organization may not support the transition. However, executive sponsorship and collaboration between staff, departments and facilities is essential. To gain consensus, HIM professionals must understand the culture of the departments involved and how to leverage their individual technological capabilities.

The work of healthcare professionals is being reshaped by the centralization of HIM operations. If you’re looking to succeed during this ambiguity of change, transforming HIM to a centralized model throughout an enterprise provides healthcare facilities with a competitive advantage, as the integration of emerging technology continues to become a crucial step towards efficient, successful operations.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and is a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Remote Release of Information: The Next Step in Secure and Compliant Exchange of Patient Health Information

Posted on July 18, 2018 I Written By

The following is a guest blog post by Patty Sheridan, MBA, RHIA, FAHIMA; SVP, Life Sciences at Ciox & Tarun Kabaria; Executive VP, Provider Operations at Ciox.

Across the industry, there is an influx of health information management (HIM) departments and medical groups moving their HIM operations from hospital main campuses and individual physician practices to centralized, offsite locations to gain efficiencies and make better use of valuable square footage in their facilities. For many organizations, this move began decades ago with the implementation of remote coding and/or the need to free up space for patient care.

These ‘virtual HIM” departments can be located at a separate facility, home-based office or remote vendor locations, and result from the continued adoption of electronic health records (EHR) and pressure to manage costs, offering HIM directors and practice administrators the opportunity to reorganize and form more efficient spaces and processes. Outsourcing functions, such as release of information (ROI), allows HIM staff to focus on other priorities of data governance while maximizing available space.

From a financial perspective, costs associated with regulations, staffing, printing, mailing and square footage are increasing; and in some instances, volumes of requests are increasing due to health plans, lawsuits and the portability of healthcare. Furthermore, allowable fees for releasing medical records are decreasing in some states. As a result of these rising financial pressures, healthcare providers are finding it more difficult to make ROI a profit center in their organizations.

HIM departments are experiencing additional pressures from rising health plan request volumes, requiring flexible operational solutions in order to meet the increasing demand. In a typical year, the volume of health plan requests tends to increase to the order of 20-30 percent, and this year those numbers are expected to triple. With such an influx of requests, moving to a virtual model allows for the onsite staff to be augmented with the remote team, fulfilling these large volume requests without impacting the core ROI and patient requests.

Another prevalent challenge is timeliness. With the advent of rebranding the Meaningful Use program to focus on promoting interoperability and the increase in various governmental and payor audits, timeliness of response to requests for medical records is critical and penalties for non-compliance are steep. As such, healthcare providers are reaching the point of diminishing returns in regards to managing the ROI function on their own, and in some cases, will not be able to meet the time deadlines imposed upon them to gain incentives, avoid penalties and takebacks.

These new industry influences create the need for even faster, more efficient, error-free fulfillment of medical record requests and pave the way for a new approach designed to help your organization meet this demand: Remote ROI.

The Remote ROI Process

The ROI process is a time-consuming administrative challenge for HIM professionals, requiring compliance expertise, secure and efficient technology, and a trained and knowledgeable staff. The Remote ROI process starts at your healthcare facility when requests for release of health information are received. From there, your chosen third party vendor, such as Ciox, receives the request from the hospital or practice via a mutually agreed upon, secure mechanism. Securely connected and able to access the hospital or practice EHR, an offsite ROI Specialist then reviews the requests for proper authorizations, identifies and captures the records to be released, and transmits the medical records from your facility’s EHR in an encrypted electronic format to the third party vendor’s ROI centralized processing center. The release is delivered to the requestor through an automatic print and mail process or electronically via a secured delivery method. Ciox’s process is computer-assisted using artificial intelligence and natural language processing thereby reducing turnaround time, improving patient satisfaction and ROI outcomes.

When creating your Remote ROI process, follow these three fundamental steps to ensure its success:

1. Determine the method of access to the Request Letter/Authorization received by the hospital or physician practice.

There are several mechanisms by which requests and authorizations are securely made available to Remote ROI Specialists for ROI processing. The most common methods include:

  • Requests/Authorizations are scanned into the EHR – Staff at the facility scans the requests/authorizations into the EHR. The Remote ROI Specialist accesses the EHR to view the information and begin the process.
  • Requests/Authorizations are faxed – Staff at the facility faxes the requests/authorizations to a fax-in queue provided by the third party vendor. The Remote ROI Specialist accesses the fax-in queue to view the information.
  • Requests/Authorizations are scanned and placed in a shared folder – Staff at your facility scans the requests/authorizations into a shared folder accessible by the Remote ROI Specialist at the third party vendor’s secure Remote ROI Processing Center.
  • Requests/Authorizations are automatically received via health data exchange or health information exchange.

2. Establish connectivity to the EHR to validate the authorization, review the medical records and process the request.

An acceptable baseline for securing the connection to your EHR system(s) must be established for Remote ROI. The appropriate connectivity scenario depends on the underlying technologies at your facility. When understanding which technologies are at your disposal and establishing connectivity, remember that security is key in this part of the process. Keep that in mind when selecting a third party vendor, as it’s paramount to select a company that makes the security of the exchange of protected health information a top priority. Furthermore, it’s of critical importance to select a vendor that has earned certified status for information security by the Health Information Trust (HITRUST) Alliance. The HITRUST CSF Certified Status ensures that key healthcare regulations and requirements for protecting and securing sensitive private healthcare information are met.

3. Ensure compliance standards to track when and who accessed protected health information.

As an added security effort, it’s crucial to follow compliance standards that allow insight as to who accessed patient health information and when it was accessed. To ensure maximum security, computers located at the third party’s Remote ROI processing facility should be secured utilizing encryption, anti-virus protection and web filters.

Passwords should be provided by the facility for access to their specific EHR and stored in an electronic password vault. The password vault should be linked to the third party’s directory that is only accessible by the ROI Specialist using their directory account. Third parties should provide complete audit trail capabilities to track personnel accessing the EHR and processing medical record requests from your applications.

By moving some or all of the onsite ROI functions to a Remote operation, you can streamline the ROI workflow, reclaim square footage for other purposes and have additional capacity available for request volume fluctuation. As an added benefit, the immediate access to requests and authorizations speeds turnaround times on processing requests, which is particularly important when considering tight timelines for meeting Meaningful Use and audit-related releases.

If you’re looking to make HIM operations more efficient and cost effective, Remote ROI can open the doors to achieving those goals.

About Ciox
Ciox is a health technology company working to solve the clinical data illiquidity challenge by providing transparency across the healthcare ecosystem and helping clients manage disparate medical records and a proud sponsor of Healthcare Scene. When stakeholders do not have timely access to the complete clinical picture of patients, critical decisions about patient care, medical outcomes research, disease prevention, reimbursement, and payments are sub-optimized. Ciox’s scale, expertise, expansive provider network and industry leading technology platform make it the most reliable clinical data company in the US. Through its standards based technology platform, HealthSource, Ciox helps clients securely and consistently solve the last mile challenges in clinical interoperability.  Learn more about Ciox’s technology and solutions by visiting www.ciox.com

Preview of #AHIMACon17 – HIM Scene

Posted on September 7, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

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I thought it might be interesting to check out the #AHIMACon17 conference hashtag for the AHIMA Annual Convention to get an idea of what the hot topics were going to be going into the annual convention. Unfortunately, there wasn’t much conversation happening on the hashtag yet. Here’s a sample of a few things I found and some of my commentary about each.


I’m excited to hear Viola Davis as well. I’m sure she has some amazing stories. It’s not clear to me her connection to healthcare, but I’m all about hearing the stories of successful people. I hope they let her tell her story and not try to have her be a healthcare speaker. Ironically, the MGMA Annual Conference is happening at the same time as the AHIMA Annual Convention about 45 minutes away. Viola Davis is keynoting both. I’m not sure if they planned this together or if it’s just coincidence. Either way, I guess I get 2 chances to hear Viola, but trying to manage both events is hard.


This tweet from Ciox made me laugh. There’s a lot of things in healthcare that are still stuck in the 80s. As Mr. H from HIStalk likes to say, Healthcare is where old technology goes to die. There’s certainly some modernization that could happen at about every healthcare organization.


This tweet is ironic after the above tweet talking about the need to modernize. I wonder how many in the AHIMA community are familiar with NLP based technology. For those not familiar, NLP stands for natural language processing. It can be used in a variety of ways, but in the AHIMA world it’s most commonly used to analyze medical records and assess if the documentation matches the coding. It’s pretty amazing technology. I also love seeing NLP used on narrative sections of a note to identify granular data elements that could be used to better inform clinical decision support tools. Do many HIM professionals care about this technology? Are they using it? I think I’ll ask when I’m at the event.


I think security will be an extremely hot topic this year. Given HIM’s role in doing release of information (ROI), it’s always had an important role. In fact, they have a pre-conference Privacy & Security Institute that I’ve heard a lot of great things about. I’m hoping to go this year if they let press attend.

Will you be at #AHIMACon17? What do you expect to be the hot topics? Are there sessions you absolutely must attend? Who’s going to throw the best party? I hope to see many of you at the conference!

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